Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Editor’s note on the Foreword to the third edition
- Foreword to the third edition
- Foreword to the second edition
- Foreword to the first edition
- Preface
- Acknowledgments
- List of acronyms
- Introduction
- Section I Skeletal trauma
- Chapter 1 The skeleton: structure, growth and development, and basis of skeletal injury
- Chapter 2 Skeletal trauma: general considerations
- Chapter 3 Lower extremity trauma
- Chapter 4 Upper extremity trauma
- Chapter 5 Bony thoracic trauma
- Chapter 6 Dating fractures
- Chapter 7 Differential diagnosis I: diseases, dysplasias, and syndromes
- Chapter 8 Differential diagnosis II: disorders of calcium and phosphorus metabolism
- Chapter 9 Differential diagnosis III: osteogenesis imperfecta
- Chapter 10 Differential diagnosis IV: accidental trauma
- Chapter 11 Differential diagnosis V: obstetric trauma
- Chapter 12 Differential diagnosis VI: normal variants
- Chapter 13 Evidence-based radiology and child abuse
- Chapter 14 Skeletal imaging strategies
- Chapter 15 Postmortem skeletal imaging
- Section II Abusive head and spinal trauma
- Section III Visceral trauma and miscellaneous abuse and neglect
- Section IV Diagnostic imaging of abuse in societal context
- Section V Technical considerations and dosimetry
- Index
- References
Chapter 15 - Postmortem skeletal imaging
from Section I - Skeletal trauma
Published online by Cambridge University Press: 05 September 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Editor’s note on the Foreword to the third edition
- Foreword to the third edition
- Foreword to the second edition
- Foreword to the first edition
- Preface
- Acknowledgments
- List of acronyms
- Introduction
- Section I Skeletal trauma
- Chapter 1 The skeleton: structure, growth and development, and basis of skeletal injury
- Chapter 2 Skeletal trauma: general considerations
- Chapter 3 Lower extremity trauma
- Chapter 4 Upper extremity trauma
- Chapter 5 Bony thoracic trauma
- Chapter 6 Dating fractures
- Chapter 7 Differential diagnosis I: diseases, dysplasias, and syndromes
- Chapter 8 Differential diagnosis II: disorders of calcium and phosphorus metabolism
- Chapter 9 Differential diagnosis III: osteogenesis imperfecta
- Chapter 10 Differential diagnosis IV: accidental trauma
- Chapter 11 Differential diagnosis V: obstetric trauma
- Chapter 12 Differential diagnosis VI: normal variants
- Chapter 13 Evidence-based radiology and child abuse
- Chapter 14 Skeletal imaging strategies
- Chapter 15 Postmortem skeletal imaging
- Section II Abusive head and spinal trauma
- Section III Visceral trauma and miscellaneous abuse and neglect
- Section IV Diagnostic imaging of abuse in societal context
- Section V Technical considerations and dosimetry
- Index
- References
Summary
Introduction
Fractures are common in fatally abused infants and young children and imaging assessments of skeletal injuries have been an important focus of postmortem studies (1–21). Computed tomography (CT) and magnetic resonance imaging (MRI) have also been used to assess for skeletal, visceral, central nervous system, and soft tissue injuries (22–28). Although a thorough autopsy provides information regarding the presence of fractures of the skull, bony thorax, and other major skeletal injuries, a thorough gross autopsy may offer little evidence of other associated skeletal injuries described in depth in this text (see Chapters 2–6). Radiologic evaluation is most critical in the assessment of high-specificity indicators of abuse, such as the classic metaphyseal lesion (CML), and other subtle injuries involving the extremities, spine, and shoulder girdle. The diagnosis of abuse in infant fatalities, as in living infants, frequently rests on the existence of prior injuries, and the recognition of early signs of healing at postmortem assessment is critical. In the author’s study of 31 abused infant fatalities, 93% of infants with extracranial fractures showed evidence of healing injuries on postmortem skeletal studies (6).
Even when the gross autopsy provides initial information regarding the presence of fracture involving the cranial vault, radiologic evaluation of the skull is an important complement to direct inspection. It is also true that gross inspection gives information regarding acute rib fractures, but a thorough radiologic evaluation of the rib cage, with specimen radiography, may reveal additional fractures, particularly those near the costovertebral articulations (7, 29). Recent healing fractures are usually detected upon careful gross inspection, but mature fractures may be missed. Furthermore, the radiologic criteria for assessment of the age of healing rib fractures are more precise than what can be determined by direct inspection. The radiologic evaluation should be followed by histologic analysis, and the ultimate assessment of the injury should be based on a combination of the gross autopsy, radiologic study, and histologic examination. Conventional CT has value in the postmortem assessment, particularly with respect to rib injuries, but at this time it should be seen as a complement and not a substitute for radiography. It may also miss fractures noted at gross autopsy (28). High-resolution CT is, however, useful for the detailed assessment of individual fractures (see below) (27).
- Type
- Chapter
- Information
- Diagnostic Imaging of Child Abuse , pp. 335 - 342Publisher: Cambridge University PressPrint publication year: 2015
References
- 1
- Cited by